Transformation Center Appointment Request

Please complete the form below to request an appointment with the Transformation Center.

First Name *

Last Name *

Date of Birth * +

Gender *

Mobile Phone *

Email Address *

Is this for a new appointment or a recurring series of appointments you've already begun? *

New Appointment

Recurring Appointment

Do you attend Bethel Austin on a regular basis? *

Yes

No

What type of appointment are you requesting? *

Counseling

Sozo

Which situation best describes your request for counseling? *

Do you prefer this session to be in person or over video? *

In-Person

Video

Please briefly explain your reason for requesting a ministry appointment. *